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SPECIAL PERMIT Date . .. . . ... . .. .19. . . . <br /> File .. To Building Inspector <br /> Application for Special Permit You are hereby authorized to issue <br /> a "Special Permit" for this applica- <br /> tion for signature of the Board of <br /> Appeals and are hereby advised that <br /> this application has received the <br /> ... . .. . .. .. . .. . . .. .. ... . .. . . .. . . .. . . approval of the Board of Appeals. <br /> Name <br /> If any conditions are written below, <br /> .. .. .. . .. . . . . . . .. . . .... .. . . you are requested to see that they <br /> Location are complied with, and included in <br /> .� permit. <br /> Conditions (if any) . . ... . .. .. . . . . . <br /> c .. ........ .. .. .. . .. . . . . .. . .. .. . .. . . <br /> � « <br /> Permit granted ( .. . . .. . . ) .. .. .. . . . . .. . . .. . . . . .. . . . . . . . . <br /> Yes or No <br /> e� <br /> -� Date . . . . .. .19. . . . <br /> Ifpermit was granted what other . . .. .. . . . . .. .. .. .. .. .. . . .. . . ..• • • • • <br /> permits were issued by the Building <br /> Department? <br /> . . . ... . .. . . .. . . . .. . ... .. . . .. ... . . . . . . <br /> To Build? .. . . . .. . <br /> (Yes or No) (date) <br /> . . . .. . . .. . . .. . .. .. .. ... .. . . . .. . <br /> r <br /> Use & Occupancy? . . .. . . .. . . . . . . . . .. . .. . .. . .. . . . .. . . . of Appeals <br /> - (Yes or No) (date) Board <br />